Diabetes Flash Flashcards
Blood glucose levels to diagnose T2D.
> 7 mmol/L FPG. >11.1 OGT. >11.1 casual PG w/ symptoms. (polydipsia, uria, phagia)
Drugs that cause dyslgycemias (5)
Atypical Antipsychotics, thiazides/loop diuretics, Beta blockers, steroids, HIV protease inhibitors.
Long acting insulins (4)
Insulin NPH (humulin N, novolin NPH). Insulin detemir (levemir), insulin glargine (lantus)
Short acting insulins (4)
Humulin R, Novolin Toronto, Insulin aspart (novorapid), insulin glulisine (apidra), insulin lispro (humalog)
How to empirically start T1D on insulin, or switch T2D to insulin.
0.5 units/kg insulin. Split 40% (long acting HS) 60% (short acting split TiD with meals)
How to add insulin to T2DM regimen
0.1-0.2 units/kg HS
Mild Hypoglycemia occurs at what level, and what symptoms.
< 4.0 mmol/L Irritability, sweating, tremors, nausea, weakness.
Severe hypoglycemia symptoms occur at what level and what symptoms.
< 2.8 mmol. Confusion, disorientation, coma.
How to treat hypoglycemia, how much does this increase BG.
15g of CHO. Ie. 6 life savers, 1 cup of milk, 3/4 up OJ or soda.
Treatment of T2D: what A1C do we start drug therapy immediately? Alternatively? How long to achieve new A1C targets?
> 9% - start 2 agents. <9% try exercise x 3months. Try to achieve target in 9-12months.
The target FPG for T2D, the target post prandial PG. Target A1C. Target BP.
4-7mmol/L. 5-10 mmol/L. 7%. 130/80.
Which insulins can you NOT mix.
Lantus (glargine). Levemir (detemir)
T2D drug of choice in pregnancy. Alternative (2)
Insulin (SWITCH to this in most cases from oral agents. If unable to use insulin: Glyburide. Metformin.
Insulins which are cloudy.
Insulin NPHs.
The only sulfonylurea indicated in pregnancy.
Glyburide
Sulfonylureas which are cleared renally (2)
Glyburide, Chlorpropamide
Adverse effects of sulfonyl ureas.
Hypoglycemia. Weight gain. (sulfa skin rash?). Interacts with salicylates, MAOis, Azoles, (inhibit metabolism) to increase risk of hypoglycemia.
Meglitinide drugs (brand/generic), dosage.
Repaglinide, Gluconorm. Nateglinide - Starlix. Take before meals, allows flexibility, because if skip a meal, can skip a dose (unlike gliclazide MR - where skipping meals is bad.)
Meglitinides are cleared by.
Cyp 3A4 metabolism (not renally cleared)
Acarbose Adverse effects.(2)
Contraindicated in. (1)
GI intolerance, (flatulence, diarrea, cramps) Liver failure
Inflammatory bowel disease.
Oral Antihyperglycemic drugs that are weight neutral.
Acarbose, Metformin.
Oral Antihyperglycemic drugs that are weight Negative
Liraglutide
Oral Antihyperglycemic drugs that are weight Positive
Sulfonylureas, TZDs, meglitinides,
DPP4 inhibitor drugs. Brand/generic. Adverse effects (1).
Januvia (sitagliptin), Onglyzza (saxagliptin), Nasopharyngitis (sore throat).
Metabolism of DPP 4 inhibs (2)
Both renally eliminated. Sitagliptin no cyp interactions. Saxagliptin - Cyp3A4 interactions (sax gets around)
TZD drugs (2) and adverse effects (2)
Rosiglitazone (avandia), pioglitazone (actos).
Fluid retention (edema, CHF).
Increased Fractures
Oral antihyperglycemic drugs which are renally eliminated. (5)
Those which are contraindicated in acute renal failure.(3)
Glyburide, Chlorpropamide, sitagliptin, saxagliptin, metformin.
Metformin, glyburide, chlorpropamide.
Adverse effects of GLP agonist.
Contraindicated in. (2)
Liraglutide (victoza). Nausea/ vomiting/Diarrhea. Nasopharyngitis.
Thyroid cancer. Pregnancy.
